Military advocacy groups are calling for changes that give working-age retirees a longer grace period if they fail to set up a way to pay new fees for Tricare Select set to kick in Jan. 1.

As it is, if the retirees fail to set up their payments by Jan. 1, they’ll be kicked out of the health care program, and will have 90 days to apply for reinstatement.

Many advocacy organizations are hearing complaints about the new fees from angry members who may not have realized fees were coming, said Karen Ruedisueli, director of health affairs for the Military Officers Association of America. “Some of the angriest are the recent retirees who served almost their entire careers while our nation was at war and endured multiple combat deployments, only to face fee increases as they’re about to retire,” she said.

Starting Jan. 1, working-age retirees must pay an enrollment fee of $12.50 per month or $150 per year for individuals; and $25 per month or $300 a year for families.

MOAA and National Military Family Association want that 90-day grace period to be extended to 12 months, over concerns that retirees may lose health care coverage because they aren’t aware of the new requirement to pay enrollment fees. They also want retroactive coverage.

“We are seeking an extension to the grace period for Tricare reinstatement with retroactive coverage in the event someone misses the communication and fails to pay the enrollment fee by Jan. 1,” Ruedisueli said.

There were 407,431 military retirees and 764,936 retiree family members in Tricare Select at the end of 2019, according to a DoD report.

This doesn’t affect those in Tricare for Life. These fees affect retirees and their family members in the so-called Group A — the sponsor’s initial enlistment or appointment was before Jan. 1, 2018. The retirees in Group A are generally working-age retirees under age 65.

“Many beneficiaries understandably do not realize Congress passed this [Tricare Select] enrollment fee back with the [fiscal 2017 defense authorization act] and it is actually significantly lower than was proposed, thanks to the efforts of numerous associations who fought it,” Ruedisueli said. The provision was part of Tricare reform that was signed into law in 2016 by President Barack Obama.

MOAA and other organizations opposed the enrollment fee when it was proposed during the legislative process, she said. The Tricare reform was an 18-month process that began with a proposal to completely get rid of Tricare.

The 2016 law gave the Defense Health Agency discretion in deciding when to start charging working-age retirees enrollment fees for Tricare Select. But information was not immediately available from Defense Health Agency officials about whether it has the authority to extend the grace period to one year.

“There are sure to be retirees who don’t find out about the new fee by January 1,” said Eileen Huck, deputy director for health care for the National Military Family Association.

Advocates point to past transitions that were problematic, where despite the Defense Health Agency’s efforts, it was difficult to reach every beneficiary with updates about actions they needed to take to ensure their benefit continued. “Inevitably, some beneficiaries only learn about a new requirement when they try to use their benefit and find out they no longer have coverage,” Ruedisueli said.

In early 2019, officials with the Office of Personnel and Management extended the deadline by three months for beneficiaries to enroll in the Federal Employees Dental and Vision Insurance Program, known as FEDVIP, partly to help military retirees who were newly eligible for FEDVIP and missed the deadline to sign up. Some retirees didn’t realize they were losing their coverage in the Tricare Retiree Dental Program at the end of 2018.

MOAA also notes the disruption of the pandemic, “making it even more difficult to catch the attention of beneficiaries with critical enrollment fee information,” Ruedisueli said.

The communications from Tricare about open enrollment season may cause some confusion, as officials have told beneficiaries they don’t have to take any action if they want to stay in their same plan, and that message is still being conveyed on the Tricare website. But retirees who need to set up payments through allotment, electronic funds transfers, debit or credit card, must do so during the open enrollment period.

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A biennial report from the Congressional Budget Office (CBO) offering options to cut the deficit includes several proposals which could weaken or eliminate earned benefits for nearly all members of the uniformed services and Veteran communities.

The CBO provides a 10-year overview of deficit-reduction measures once every two years, before the start of a new congressional session. As with past years, the report includes ways to reduce both mandatory and discretionary funding, as well as ways to increase federal revenue... but it does not consider any long-term implications of these potential savings, nor the impact cuts would have on affected communities or on significant challenges facing the nation, such as military recruitment and retention.

These proposals, if enacted, could cost servicemembers past and present – and their families, survivors, and caregivers – thousands of dollars every year. Retirees and survivors would face TRICARE For Life enrollment fees and increased medical costs, and receive smaller cost-of-living increases for their retirement pay and survivor benefits. Veterans would see significant reductions in available VA care and reduced benefit payments. Servicemembers and their families would suffer from a cap on pay raises and cuts to a critical housing benefit.

MOAA has identified 13 options from the CBO report which could inflict such harm; we will continue to fight for our constituents to ensure proposals like these are not enacted, or even considered.

Mandatory Spending

• Introduce Enrollment Fees for TRICARE For Life
• Introduce Minimum Out-of-Pocket Requirements in TRICARE For Life
• Means-Test VA Disability Compensation for Veterans with Higher Income
• End VA’s Individual Unemployability Payments to Disabled Veterans at the Full Retirement Age for Social Security
• Reduce VA’s Disability Benefits for Veterans Who Are Older Than the Full Retirement Age for Social Security
• Narrow Eligibility for VA’s Disability Compensation by Excluding Veterans With Low Disability Ratings
• Use an Alternative Measure of Inflation to Index Social Security and Other Mandatory Programs

Discretionary Spending

• Cap Increases in Basic Pay for Military Service Members
• Replace Some Military Personnel With Civilian Employees
• Reduce the Basic Allowance for Military Housing to 80 Percent of Average Housing Costs
• Increase Prescription Drug Copayments for All Veterans
• End Enrollment in VA Medical Care for Veterans in Priority Groups 7 and 8

Revenues

• Include VA’s Disability Payments in Taxable Income

How You Can Help

We need to let Congress know where beneficiaries stand on these issues. Watch The MOAA Newsletter and MOAA’s Advocacy News page for ongoing updates throughout the year, beginning next month with an opportunity to tell Congress what you think about the CBO’s ideas to increase out-of-pocket costs for Tricare For Life beneficiaries, especially in the face of recent cuts to the TRICARE retail pharmacy network.

Learn how you can make a difference on all of MOAA’s advocacy issues by visiting our Legislative Action Center.

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The Pentagon is downsizing or closing 50 medical clinics, including 12 on Air Force bases, in a move the department says will “increase the readiness of our operational and medical forces.” But the change will also force families and retirees away from some USAF facilities and into TRICARE civilian providers.

The Fiscal 2017 National Defense Authorization Act called on the Pentagon to analyze its hospital and clinic footprint, and the department screened 343 facilities inside the United States. Of those, 77 were selected for additional assessments and 50 ultimately chosen for “restructuring.”

The majority of those facilities will transition from serving all beneficiaries to only seeing Active-duty military personnel. Family members, retirees, and their families would have to seek care through the TRICARE civilian provider network.

Matt Donovan, the former acting Air Force secretary who is performing the duties of the under secretary of defense for personnel and readiness, outlined the changes in a Feb. 19 report to congressional leaders.

The report is a “strategic framework” for the changes, and no detailed implementation plan, timeline, projected costs, or expected savings are available yet. Local networks’ ability to take on additional patients will drive the transition time, and switching people over could take several years.

If TRICARE networks cannot provide access to quality care, “DOD will revise implementation plans,” according to a Military Health System release.

MacDill Air Force Base, Fla.’s Sabal Park Clinic will close once all patients are transferred. The clinic opened in May 2019.

Joint Base Langley-Eustis Air Force Base, Va.’s 633rd Medical Group’s inpatient facility will become an ambulatory surgical center.

The following facilities will switch to Active-duty, occupational health-only clinics:

• MacDill’s 6th MDG outpatient facility
• Dyess AFB, Texas’s 7th MDG outpatient facility
• Robins AFB, Ga.’s 78th MDG outpatient facility
• Barksdale AFB, La.’s 2nd MDG outpatient facility
• Dover AFB, Del.’s 436th MDG outpatient facility
• Goodfellow AFB, Texas’s 17th MDG outpatient facility
• Hanscom AFB, Mass.’s 66th Medical Squadron outpatient facility
• Maxwell AFB, Ala.’s 42nd MDG outpatient facility
• Joint Base McGuire-Dix-Lakehurst, N.J.’s 87th MDG outpatient facility
• Patrick AFB, Fla.’s 45th MDG outpatient facility

The Pentagon expects about 200,000 beneficiaries to move to provider networks, the majority of which are retirees. They will need to pay out of pocket for health care provided through TRICARE. A family of four filling a dozen prescriptions per year could end up spending from $157 to $720 more per year on prescription medications alone. For medical care, copays and deductibles could add hundreds or thousands more dollars.

By only providing medical services to Active-duty forces, the Pentagon wants to make sure affected facilities can help service members be “medically ready to train and deploy,” said Tom McCaffery, the assistant secretary of defense for health affairs, in a release. “It also means MTFs are effectively utilized as platforms that enable our military medical personnel to acquire and maintain the clinical skills and experience that prepares them for deployment in support of combat operations around the world.”

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Pentagon officials on Wednesday released a list of military treatment facilities and clinics that will no longer provide care to military retirees and active-duty families as part of a shift in focus to supporting active-duty readiness.

"The military health system is in the midst of implementing several significant reforms aimed at building a more integrated and effective system of readiness and health," said Tom McCaffery, assistant secretary of defense for health affairs. "We reviewed all facilities through the lens of their contributions to military readiness -- that includes MTFs [being] operated to ensure service members are medically ready to train and deploy. It also means MTFs are effectively utilized as platforms that enable our military medical personnel to acquire and maintain the clinical skills and experience that prepares them for deployment in support of combat operations around the world."

The list is included in a 61-page report to Congress delivered Wednesday. The report lays out the process through which officials selected the locations slated for changes.

Those changes, first announced in a Feb. 3 memo obtained by Military.com, are slated to impact 200,000 retirees and active-duty family members. Of those, officials said Wednesday, about 80,000 are active-duty family members, while the remaining 120,000 are retirees and their families.

Of the 38 facilities that will no longer see retirees or family members, 24 are slated to shift to active-duty only over the next several years, officials said. Eleven clinics have already started the process of moving to active-duty only, and three are slated to close to all users.

An additional four facilities are slated for downgrades. For example, the hospital at Marine Corps Air Station Beaufort, South Carolina, will downgrade to an ambulatory care center under the plan. Two facilities will shift to mostly active-duty care, but will take families as needed. And two hospitals could be given upgrades, including the hospital at Camp Lejeune, North Carolina.

While officials said military readiness, not cost savings, is the primary driver for the changes, pushing retirees and active-duty families into the community for care should save the system money.

For 2021, that savings is expected to reach about $36 million, officials said.

"We have generally found that, through our contracts, that our care often is cheaper in the network from a government purchase point of view than the cost of actually doing it within our direct-care system in some locations," Dr. Dave Smith, deputy assistant secretary of defense for force health, told reporters. "And clearly, as part of our methodology, that was one of the questions we asked, but our principal question was, 'Are we getting readiness value out of this location that is worth the cost, if you will, compared to putting that somewhere else in the system.'"

But the changes will bring higher costs to many users forced to see doctors within the civilian community. For retirees on Tricare Prime, receiving care off base costs $20 per visit for primary care and $31 for specialty care. That’s for in-network doctors outside the MTF, and comes on top of a $600 per family annual registration fee.

For active-duty families on Tricare Prime, the change will carry no out-of-pocket costs.

The Feb. 3 memo noted that "in many cases" all users will still be able to receive pharmacy services at the impacted facilities.

All the clinics listed as shifting to active duty-only were noted as keeping pharmacy service for all users. However, pharmacy services provided by the facilities slated for complete closure will cease. That means users who previously received drugs from those facilities will need to shift to a different military pharmacy or pay out of pocket for drugs from a local retail pharmacy or mail order.

Officials told reporters Wednesday that no clinics identified for transition will do so until care is secured within the civilian community for each patient, a process that they said could take as long as five years. The Defense Health Agency, which manages the Tricare program and its private contractor, will oversee that process, McCaffery said.

"It will be the Defense Health Agency working with the local MTF leader, the installation commander and our Tricare network partners in making those determinations in terms of assessing the ability of that civilian health care market to take on additional patients," he said. "We recognize that this is an MTF by MTF, market by market implementation."

Officials said they examined more than 300 military health facilities as part of their review. Of those, they looked at 77 for a "detailed assessment" and determined that 50 warrant changes. Thirty-eight were then identified as having the necessary nearby civilian medical support to absorb an influx of new patients, they said.

That civilian capacity was assessed by surveying the local provider network and working with base commanders and MTF officials, the report says.

For example, researchers looked at primary, specialty and in-patient care within specific drive-time standards. For primary care, officials looked at providers within 15 miles of the current MTF for urban areas, and 30 miles for rural areas. For specialty care, the standard was 40 miles for urban areas and 55 miles for rural areas. And for in-patient hospital care, the standard was a 60-minute drive time.

For in-patient care, special attention was paid to labor and delivery services, the report states. In many cases, it notes, decisions were made specifically based on that issue. For example, at Fort Campbell, Kentucky, closing Blanchfield Army Medical Center to non-active duty patients is not an option because the local hospitals, in nearby Hopkinsville, Kentucky, and Clarksville, Tennessee, would not be able to handle a resulting 267% increase in annual deliveries, the report states.

Below is a list of facilities slated for changes or closures. The list can also be downloaded here. The complete report to Congress is available here.

Facilities closing to non-active duty patients include:

• Goodfellow Air Force Base, Texas, outpatient clinic
• Barksdale Air Force Base, Louisiana, outpatient clinic
• Maxwell Air Force Base, Alabama, outpatient clinic
• Dover Air Force Base, Delaware, outpatient clinic
• Hanscom Air Force Base, Massachusetts, outpatient clinic
• MacDill Air Force Base, Florida, outpatient clinic
• Robins Air Force Base, Georgia, outpatient clinic
• Dyess Air Force Base, Texas, outpatient clinic
• Joint Base McGuire-Dix-Lakehurst, New Jersey, outpatient clinic
• Navy Weapons Station Earle, New Jersey, Colts Neck Earle clinic
• San Onofre Marine Corps Base, California, San Onofre Health Clinic
• Fort Bragg, North Carolina, Joel clinic and Robinson clinic
• Marine Corps Logistics Base Albany, Georgia, Naval Branch Health Clinic Albany
• Naval Support Facility Dahlgren, Virginia, Naval Branch Health Clinic Dahlgren
• Naval Submarine Base New London, Connecticut, Naval Branch Health Clinic Groton
• Naval Support Facility Indian Head, Maryland, outpatient clinic
• Naval Air Station Belle Chasse, Louisiana, outpatient clinic
• Naval Support Activity Mid-South, Tennessee, outpatient clinic
• Portsmouth Naval Shipyard, New Hampshire, outpatient clinic
• Fort Detrick, Maryland, Barquist outpatient clinic
• Defense Distribution Center in New Cumberland, Pennsylvania, outpatient clinic
• Redstone Arsenal, Alabama, outpatient clinic
• Fort Lee, Virginia, Kenner-Lee outpatient clinic
• Aberdeen Proving Ground, Maryland, Kirk Army Health outpatient clinic

Facilities that have either already transitioned to active duty-only, or are in process:

• Fort Riley, Kansas, Farrelly Health Clinic
• Fort Hood, Texas, Fort Hood Medical Home and Charles Moore clinic
• Naval Support Activity Lakehurst, New Jersey, Naval Behavioral Health Clinic Lakehurst
• Marine Corps Air Station Miramar, California, Rancho Bernardo clinic
• Presidio of Monterey, California, outpatient clinic
• Rock Island Arsenal, Illinois, outpatient clinic
• Naval Air Station Corpus Christi, outpatient clinic
• Naval Station Newport, Rhode Island, Naval Health Clinic New England
• Naval Air Station Patuxent River, Maryland, outpatient clinic
• Joint Base Lewis-McChord, Washington, Okubo Medical Home
• Fort Carson, Colorado, Robinson-Carson outpatient clinic

Facilities that will close completely to all users:

• MacDill Air Force Base's Sabal Park community clinic in Brandon, Florida
• Fort Benning, Georgia, North Columbus-Benning clinic
• Fort Irwin, California, Department of Behavioral Health

Facilities that could see upgrades:

• Camp Lejeune, North Carolina, upgrade to Level II Trauma Center
• Tripler Army Medical Center, Hawaii, could be closed to non-active duty patients if officials determine that the local community can handle providing the necessary medical care.

Facilities slated for downgrade:

• Fort Meade, Maryland, Kimbrough, Ambulatory Care Center to downgrade to a clinic
• Marine Corps Air Station Beaufort, South Carolina, Naval Hospital Beaufort downgrade to ambulatory surgery center
• Joint Base Langley-Eustis, Virginia, downgrade to an ambulatory surgery center and outpatient clinic; McDonald clinic downgrade from ambulatory surgery to an outpatient clinic
• Fort Leavenworth, Kansas, downgrade from ambulatory surgery to an outpatient clinic

Facilities that may continue to see active-duty families

• Naval Technical Training Center Meridian, Mississippi, outpatient clinic
• Southern Command (SOUTHCOM), Miami, Florida, Gordon outpatient clinic

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Months after retirees overseas started getting word that their APO/FPO mail privileges would be cut off Aug. 24, they’re still waiting for a definitive answer.

“I think most everyone here is taking a ‘wait and see’ attitude and hoping DoD doesn’t cut us off,” said Mark Favreau, volunteer director of the U.S. Military Retiree Support Services Office for Metro Manila in the Philippines. He said retirees haven’t heard anything from DoD.

Defense officials have been reviewing retirees’ mail privileges since June. Information was not available from DoD about the status of that review.

In June, a DoD spokesman told Military Times “we are reviewing this issue to ensure authorized military postal service patrons are provided access worldwide.”

Many retirees are questioning why this change is being considered in the first place, after decades of being able to use APO/FPO addresses overseas.

According to DoD statistics, about 40,000 military retirees live overseas, plus family members of these retirees.

A major concern among military retirees is that they would no longer be able to get their prescription medications through the Tricare Express Scripts mail-order pharmacy. Express Scripts Pharmacy can only mail prescriptions to U.S.-based addresses, State Department Pouch Mail and APO/FPO/DPO addresses. The Military Postal Service Agency provides postal services to DoD personnel and their families at locations around the world.

It’s not clear where the idea for the policy change originated — the Military Postal Service Agency or someone higher up in the DoD chain.

In May, Defense Department officials published a policy change that has been interpreted to mean that the only people authorized to use the APO/FPO system are military members and their dependents, DoD civilians and their dependents, and contractors who are authorized to accompany the force. That leaves out military retirees and others, such as Red Cross employees.

After the May DoD policy change, Military Postal Service Agency officials notified their overseas postal communities that affected patrons would be given 90 days advance notice that they will no longer be able to use APO/FPO service, according to a Military Postal Service Agency email obtained by Military Times.

Agency officials “recognized the need to clarify authorized users of the [military postal system] after a legal review determined that some MPS patron categories included over time are either not authorized by law or not permitted by host nation agreement,” according to the DoD statement to Military Times in June. Those status of forces agreements vary by country.

Money is also a factor. “The same review was also unable to locate established fiscal authority for seven of the listed categories” of patrons, DoD officials told Military Times.

There are limits on the privileges. For example, in the Philippines, items are limited to one pound for retirees using the military mail system.

For retirees living overseas, losing APO/FPO mail privileges could affect a number of areas of their lives. For example, for retirees voting absentee in states that don’t have the ability to send or receive absentee ballots online, this could affect their ability to vote.

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Active-duty military families, retirees and their families and others will pay more for their medicine, starting Jan. 1.

After holding the line on pharmacy costs for 2021, Tricare officials are increasing co-payments for 2022, with increases ranging from $1 to $8.

The increase, however, doesn’t affect active-duty service members themselves, who pay nothing for their covered medications through military pharmacies, retail network pharmacies and through the home delivery benefit. The increase also doesn’t apply to survivors of active-duty service members, or to medically retired service members and their family members, according to an announcement by Tricare officials.

The military pharmacy is still the lowest cost option for military beneficiaries; as always, there’s no cost for covered generic and brand-name drugs at these pharmacies.

The increases will apply to all categories of drugs: generic formulary drugs, brand-name formulary drugs and non-formulary drugs, and costs will depend on the type of pharmacy used.

Tricare formulary drugs are generic and brand-name prescription drugs that are covered by Tricare. You can search the list of formulary drugs here.

Tricare covers most prescription drugs approved by the Food and Drug Administration. Prescription drugs may be covered under the pharmacy benefit or the medical benefit.

The changes in co-pays taking effect Jan. 1:

Tricare Pharmacy Home Delivery (up to 90-day supply)

*Generic formulary drugs co-pays increase from $10 to $12

*Brand-name formulary drugs increase from $29 to $34

*Non-formulary drugs increase from $60 to $68

Tricare retail network pharmacies (up to 30-day supply)

*Generic formulary drugs increase from $13 to $14

*Brand-name formulary drugs increase from $33 to $38

*Non-formulary drugs increase from $60 to $68

Non-network pharmacies (up to 30-day supply)

*Generic formulary drugs and brand-name formulary drugs will increase from $33 to $38, or the co-pay will be 20 percent of the total cost of the drug, whichever is greater, after meeting the annual deductible.

*Non-formulary drugs will increase from $60 to $68, or the co-pay will be 20 percent of the total cost of the drug, whichever is greater, after meeting the annual deductible.

Non-network pharmacy costs stay the same for those who use a Tricare Prime plan, where you pay a 50-percent cost-share after meeting your point-of-service deductible for covered drugs.

Some brand-name maintenance drugs — taken for long-term conditions —can only be filled twice at retail network pharmacies. After the second refill, beneficiaries must use the home delivery option or a military pharmacy.

If you have other health insurance that includes a pharmacy benefit, you can’t use the Tricare pharmacy home delivery option unless your other health insurance doesn’t cover that prescription, or you’ve reached the dollar limit of your other plan.

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Military retirees receiving care on bases nationwide are being quietly shifted to off-base civilian providers in a transition that has been taking place since at least 2018, Military.com has learned.

That's independent of a plan outlined in a recently obtained memo that would close 38 treatment facilities to all but active-duty patients.

The changes detailed in the Feb. 3 memo are a part of a review of military hospital operations and a system consolidation under the Defense Health Agency ordered by Congress in 2016. The memo did not list the affected facilities or make clear when the changes would start. A report on that review is expected to be delivered to Congress as early as this week.

The memo said changes would happen "in a deliberate, responsible fashion," and not until officials are "able to confirm there are available providers in the local Tricare network."

Care for military retirees enrolled in the Tricare Prime plan has long been offered at military clinics on a space-available basis, as a matter of policy.

"One of the biggest challenges and most important responsibilities we have is how to best align our resources with our patients' needs. Military hospital and clinic leaders constantly evaluate their facilities' capacity based on the number of providers available and their mix of specialties," Kevin Dwyer, a DHA spokesman, said in a statement provided to Military.com. "However, because the report to Congress has not yet been submitted, any previous changes are a result of the rebalancing of capacity based on available providers."

But as early as 2018, military hospitals and clinics had begun intentionally shifting retirees out of the hospital and into the community as a response to clinic and hospital staffing levels and restructuring sparked by the consolidation.

Military retirees pay an annual enrollment fee of $600 per family to use the Tricare Prime plan and gain access to on-base doctors. While care received on base has no out-of-pocket cost, retired Prime users must pay $20 per visit for primary care and $31 for specialty care received outside the military system. Tricare Select comes with slightly higher out-of-pocket costs -- $30 for primary and $45 for specialty care -- but no annual enrollment fee. Both plans have a $3,000 annual out-of-pocket cost cap.

For example, when Army officials announced plans to downsize Ireland Army Community Hospital at Fort Knox, Kentucky to a health clinic in 2018, retirees were told they could no longer be seen there for primary care.

"Military treatment facilities are able to see retirees on a space available basis, and Ireland has done that for years," Col. Kevin. Bass, commander of the medical center at the time, said in a news release. "But with a new clinic being built and the restrictions placed on its construction, we will not have the space to see retirees when it's finished."

At Naval Submarine Base Kings Bay, Georgia, retirees were sent letters late last year notifying them that they were no longer able to get appointments on base.

"Because our staffing won't accommodate everyone, we've taken a series of steps throughout this year to adjust [Naval Branch Health Clinic] Kings Bay's enrollment," says the letter, signed by Capt. Matthew Case, who commands Naval Hospital Jacksonville, Florida, of which Kings Bay is a subordinate command.

Hundreds of military retirees and their family members contacted Military.com following its first report about the memo Feb. 7, many of them stating that their local hospital or clinic had made a similar announcement. In other cases, readers said they were simply told their primary care provider was no longer available. In all instances, retirees who were no longer allowed on base faced new and unplanned out-of-pocket fees based on the Tricare Prime cost structure.

Readers reported being dropped from primary or specialty care at hospitals and clinics including Naval Hospital Bremerton, Washington; Tripler Army Medical Center, Hawaii; Scott Air Force Base, Illinois; FE Warren Air Force Base, Wyoming; Barksdale Air Force Base, Louisiana; Moody Air Force Base, Georgia; Robins Air Force Base, Georgia; Tyndall Air Force Base, Florida; and Submarine Base New London, Connecticut.

Only officials from Barksdale, Air Force Base and Naval Health Clinic New England, which oversees Navy medical care across the Northeast U.S., returned a request for comment.

A spokesman from Barksdale said they are waiting on a decision from Congress before determining whether or not their clinics will close to patients not on active duty. And Kathy MacKnight, a spokeswoman for the region, said while the clinics at New London and Naval Station Newport, Rhode Island, have not removed anyone, neither locations are accepting any new dependent enrollees, including active-duty family members.

Retirees aren’t the only ones concerned about the shift. Although the memo promised no immediate changes, active-duty families at Fort Bragg, North Carolina, Barksdale Air Force Base and FE Warren Air Force Base reported being either removed from care or blocked from enrolling at the military clinic.

In one case, for example, users at Fort Bragg's Fayetteville Medical Home reported losing their primary care doctor without warning in mid-December and being told to pick one in the community. In a separate case, a military spouse at the same clinic was told this week that clinic staff had been notified it is closing.

But a spokesman for Womack Army Medical Center, which oversees that clinic, said no changes have been made there.

"We are currently reassessing the best use of the space. No decision has been made. No one is being dis-enrolled and no employment is being terminated," Robert Kerns, a Womack spokesman, told Military.com.

Unlike retirees, active-duty family members enrolled in Tricare Prime but seen off-base do not pay out-of-pocket fees for care.

Despite an assurance in the memo that no patients will be moved "until we are confident the local market has providers available," many readers said they're worried that officials won't know care isn't available until it's too late. For example, one spouse at Fort Bragg reported having trouble finding an off-base provider with openings, while a retiree near Kings Bay said she had to wait over a month for her new off-base doctor to have an opening.

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Imagine you are an 80-year-old who served over 30 years of active military service — with the literal battle scars to prove it — having made plans to be buried at Arlington National Cemetery. You and your family made these plans because a burial, with the appropriate honors is what the military promised you when you joined AND when you retired. Now as you and your family think about how and where your life and sacrifice to our nation are to be honored — you discover your end-of-life plans are null and void. (Even worse — your family finds out after you are gone.)

That’s the scenario that will play out for military retirees if the Army is successful in denying burial benefits for retirees at Arlington. The changes proposed will render those who honorably served 20 or more years ineligible for in-ground burial and the military honors currently afforded to retirees at Arlington. It seems bizarre that the Army is proposing to eliminate Arlington burial benefits for Veterans alive today in order to benefit those who have yet to serve one day in uniform — but that is exactly what is before the Congress.

Equally disturbing is that the Army’s move to eliminate Arlington burials for retired Veterans is unknown to nearly all retirees. Although retirees receive regular and frequent communications from Defense Finance and Accounting Service — as well as their respective services — there has been no notice to retirees or their families that their end-of-life plans are about to be upended.

Burial space at Arlington is limited. Without some adjustment in eligibility, it may run out in 2055. The question then is who will be afforded this limited space. The answer may seem obvious. Amazingly, the Department of the Army has proposed and put before Congress regulations to break the promise made to military retirees. Without a strong message from retirees, their families and those who believe the military should keep its promise to honor and bury those who have spent 20 plus years in the service of our nation — Congress will no doubt adopt the Department of the Army’s recommendation.

An alternative recommendation is to adopt the Army’s proposal with one modification — those who are currently receiving retired pay would retain their eligibility to be buried at Arlington, as well as those who meet the newly proposed criteria for burial.

The time is now for those who care to contact their Representative and Senators and ask them to keep the military’s promise and allow retirees to be buried at Arlington.

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